ACTA DE CADENA DE CUSTODIA

DEPARTAMENTO ANTIDROGAS POLICIA NACIONAL DEL PERU - SULLANA

TIPO DE MUESTRA: ________________________________________________

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DESCRIPCION DE LA MUESTRA:
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NOMBRE DE QUIEN EMBALA Y LACRA EL BIEN INCAUTADO:

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DNI ___________________ CIP _____________________ CARGO _______________________

FECHA Y HORA DEL EMBALAJE Y LACRADO: ______________________________________

NOMBRE DE QUIEN TRASPORTA EL BIEN INCAUTADO:

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DNI ___________________ CIP _____________________ CARGO _______________________

FECHA Y HORA : ______________________________________________________

MOTIVO DEL TRASLAD : ______________________________________________________

OBSERVACIONES : ______________________________________________________
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ENTREGUE CONFORME RECIBI CONFORME

ENTREGADO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

RECIBIDO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

FECHA Y HORA : __________________________________________________________

MOTIVO TRASLADO : __________________________________________________________

OBSERVACIONES : ___________________________________________________________
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ENTREGUE CONFORME RECIBI CONFORME

ENTREGADO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

RECIBIDO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

FECHA Y HORA : __________________________________________________________

MOTIVO TRASLADO : __________________________________________________________

OBSERVACIONES : ___________________________________________________________
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ENTREGUE CONFORME RECIBI CONFORME

ENTREGADO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

RECIBIDO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

FECHA Y HORA : __________________________________________________________

MOTIVO TRASLADO : __________________________________________________________

OBSERVACIONES : ___________________________________________________________
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ENTREGUE CONFORME RECIBI CONFORME

ENTREGADO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

RECIBIDO POR : __________________________________________________________

DNI, CIP Y CARGO : __________________________________________________________

FECHA Y HORA : __________________________________________________________

MOTIVO TRASLADO : __________________________________________________________

OBSERVACIONES : ___________________________________________________________
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ENTREGUE CONFORME RECIBI CONFORME